GI Flashcards
(112 cards)
1
Q
painless rectal bleeding
blood on stools - not mixed
anal itching/irritation
external small vascular lumps 2, 7, 11 o clock
A
haemorrhoids
2
Q
haemorrhoids management
A
soften stools - dietary or laxatives
topical anaesthetic/steroids
rubber band ligation or sclerotherapy
very large haemorrhoids = surgery
3
Q
painful bright rectal bleeding
sharp pain on passing stool
constipated
A
anal fissure
4
Q
management of anal fissure
A
acute = soften stool with laxative and prescribe topical analgesics chronic = topical GTN - consider surgery or botulinum toxin
5
Q
pain around anus, worse on sitting
pus-like discharge from the anus
hardened tissue around anus
sometimes systemic features
A
anorectal abscess
6
Q
management of anorectal abscess
A
surgical incision and drainage
sometimes given Abx
7
Q
skin irritation around the anus
contant throbbing pain - worse when sitting, moving, coughing or passing stool
smelly discharge near anus
rectal bleeding
hx of rectal abscess
A
rectal fistula
8
Q
anal fistula tx
A
surgical - fistulotomy
9
Q
painful, tender lump which may be fluctuant and have purulent discharge. There may be accompanying cellulitis
usually at the tailbone/coccyx /natal cleft
usually male between 16-40yrs
A
pilonodal disease
10
Q
management of pilonodal disease
A
Incision and drainage
paracetamol for pain/fever
advise long term hygiene and hair removal techniques
11
Q
often asymptomatic
rectal bleeding, diarrhoea, abdo pain and mucous discharge
dental problems
A
polyps
12
Q
management of polyps
A
surgical - proctocolectomy with ileostomy or total colectomy with ileorectal anastomosis
13
Q
persistent blood in stool persistent change in bowel habit persistent lower abdo pain , bloating or discomfort weight loss loss of appetite
A
colon cancer
14
Q
management of colon cancer
A
surgery = cancerous section removed
chemo/radiotherapy
targeted therapies
15
Q
colon/bowel cancer screening?
A
FIT & FOB when aged 60-74 = every 2 yrs home kit
16
Q
commonly young pt 10-20yrs periumbilical pain/epigastric which radiated to RIF pain worse on coughing mild pyrexia anorexia nausea \+ve rovsing and psoas signs
A
acute appendicitis
17
Q
management of acute appendicitis
A
laparoscopic appendectomy
prophylactic Abx and fluids
18
Q
usually in infants 6-18months paroxysmal abdo pain (RUQ) vomiting red-currant jelly stool sausage shaped mass in RUQ
A
intussusception
19
Q
investigations for intussusception
A
US = target like mass
20
Q
Management for intussusception
A
reduction by air inflation and surgery
21
Q
LIF abdo pain
fever, malaise
occasional rectal bleeding
A
Diverticulitis
22
Q
management for diverticulitis
A
oral Abx, liquid diet and analgesia = mild cases
symptoms unsettled after 72hrs = admit to hospital and iV abx
23
Q
what investigation done for diverticulitis
A
erect CXR = pneumoperitoneum (presence of air/gas in peritoneal cavity
24
Q
abdominal pain
bloating
change in bowel habut
usually for 6 months
symptoms worsened by eating
passage of mucus
usually younger pts ~20-30ys
A
IBS
25
IBS management
first line - antispasmodics for pain, laxative if constiapted and loperamide if diarrhoea
second-line = low dose tricyclic eg: amitriptyline
can suggest
psychological interventions= CBT
26
management of faecal impaction in children
pulyethylene glycol 3350 + electrolytes / Movicol Paediatric Plain
add stimulant laxative
27
```
sudden onset of diarrhoea 3 or more times
- sometimes with blood or mucus
faecal urgency
abdo pain/cramps
sudden N&V
bloating flatulence, weight loss
```
gastroenteritis
| infectious diarrhoea
28
what Ix should be done in gastroenteritis
urea breath test for H.pylori
29
management of gastroenteritis
If H.pylori negative = PPI
hydrate
loperamide may help
avoid transmission
30
abdominal pain - often of sudden onset, severe and out-of-keeping with physical exam findings - sometimes post-prandial
rectal bleeding
diarrhoea
fever
bloods typically show an elevated white blood cell count associated with a lactic acidosis
ischaemic bowel disease
31
Ix for ischaemic bowel disease
CT (wall thickening)
32
management of bowel ischaemia
intial resuscitation, iV fluids and oxygen
IV broad-spec Abx
surgery - urgent laparotomy
33
```
central diffuse abdo pain
nausea and vomiting (bilious)
constipation
distended abdo
'tinkling bowel sounds'
```
recent surgery may predispose to adhesions
bowel obstruction
34
investigation for bowel obstruction
abdo X-ray = distended bowel loops
CT gives definitive diagnosis
35
management of bowel obstruction
nil by mouth, IV fluids, NG tube
| some may require surgery
36
pain, distention of the abdomen, fever, rapid heart rate, and dehydration, altered mental status
toxic megacolon
37
management of toxic megacolon
IV fluids and Abx
| colectomy
38
```
diarrhoea
prominent weight loss
ulcers, perianal disease
skip lesions
lesions from mouth to anus
cobblestone appearance
associated with gallstones
granulomas and increase goblet cells
all layers of submucosa inflamed
```
Crohn's disease
39
```
bloody diarrhoea
LLQ pain
tenesmus
continuous disease does not surpass the ileorectal valve
crypt abscesses
widespread ulceration and pseudopolyps
lower goblet cells and granuloma
```
Ulcerative colitis
40
drainpipe colon, loss of haustrations
ulcerative colitis
41
management of ulcerative colitis
mild cases = topical rectal aminosalicylate (-salazines)
severe = hospital admission - IV steroid /cyclosporin
surgery if no improvement in 72hrs
maintaining = oral azathioprine/mercaptopurine
42
management of crohn's
first line = glucocorticoids or budesonide
second line = aminosalicylates
can add oral azathioprine/mercaptopurine
eventual surgery
43
```
acidic taste in mouth
persistent cough (at night)
retrosternal pain
sore throat
dyspepsia
halitosis
```
oesophagitis
44
investigations of oesophagitis
endoscopy and pH testing
45
management of oesophagitis
antacids PPI 12 months or H2Rs
| keyhole surgery = tighten lower oesophageal sphincter
46
```
haematemesis
melaena
abdo pain
dysphagia/odynophagia
encephalopathy
pallor, hypTN, signs of sepsis
```
oesophageal varices
47
management of oesophageal varices
vasoactive drugs - adrenaline
endoscopic band ligation
prophylactic antibiotics
48
```
progressive dysphagia
heartburn
food impaction
chest pain
weight loss
persistent cough
```
oesophageal stricture
49
oesophageal stricture Ix
endoscopy, barium swallow, FBC and iron studies
50
management of oesophageal stricture
oesophageal dilation with endoscopy
| and long term PPI use
51
Usually history of antecedent vomiting.
This is then followed by the vomiting of a small amount of blood.
little systemic disturbance or prior symptoms.
repeated vomiting after binge drinking, severe morning sickness and bulimia
mallory weiss tears
52
mallory weiss tear Ix
upper endoscopy
53
management of mallory weiss tears
initial resuscitation and correct fluid loss
54
change from squamous epithelium to columnar epithelium
usually asymptomatic
some GORD symptoms
barrett's oesophagus
55
management of barrett's oesophagus
endoscopic surveillance
and high dose PPI
resection - resection/ablation
56
dysphagia of BOTH liquids and solids
typically variation in severity of symptoms
heartburn
regurgitation of food
may lead to cough, aspiration pneumonia etc
malignant change in small number of patients
achalasia/oesophageal dysmotility
57
investigations of achalasia/oesophageal dysmotility
oesophageal manometry
barium swallow = 'birds beak appearance'
chest-X-ray = wide mediastinum
58
management of achalasia/oesophageal dysmotility
pneumatic (balloon) dilation first-line
surgical intervention with a heller cardiomyotomy
intra-sphincteric injection of botulinum toxin
59
retrosternal burning pain
dyspepsia
halitosis
acid brash
GORD
60
GORD Ix
24hr pH oesophageal monitoring
| upper GI endoscopy
61
management of GORD
high dose PPI for 1 month
if no response = try H2RA or prokinetic
62
epigastric pain
nausea
dypepsia
hx of NSAID/aspirin use
peptic ulcer disease
if pain worse whilst hungry = duodenal
if pain worse after eating something = gastric
63
ulcer relieved by eating
duodenal
64
ulcer worsened by eating
gastric ulcer
65
Ix for peptic ulcer disease
urea breath test for H.Pylori
66
management of peptic ulcer disease
H.pylori positive = eradication therapy
| H.pylori negative = PPI till ulcer heals
67
dyspepsia
nausea and vomiting
anorexia and weight loss
dysphagia
usually more common in males and ~ 70s-80s
gastric cancer
68
diagnosis of gastric cancer
endoscopy with biopsy
staging = CT/endoscopic US
69
Management of gastric cancer
5-10cm proximal to the OG junction = sub-total gastrectomy
<5cm = total gastrectomy
carcinoma of the cardia= oesophagogastrectomy
70
'projectile' vomiting, typically 30 minutes after a feed
constipation and dehydration may also be present
a palpable mass may be present in the upper abdomen
hypochloraemic
hypokalaemic
alkalosis
pyloric stenosis
71
diagnosis of pyloric stenosis
ultrasound
72
management of pyloric stenosis
Ramstedt pyloromyotomy
73
symptoms of peptic ulcer disease
generalised epigastric pain
syncope
peptic ulcer perforation
74
haematemesis
melena
hypotension
tachycardia
peptic ulcer haemorrhage
75
peptic ulcer haemorrhage management
Calculate risk using Glasgow-Blatchford Score
if suspected variceal bleeding = terlipressin & prophylactic Abx
- will also have band ligation
upper GI endoscopy within 24hrs
- clipping with/out adrenaline
calculate ROCKALL score
76
```
hepatosplenomegaly - painful/tender
fatigue
jaundice
loss of appetite
nausea
```
GGT raised
AST:ALT >2 (>3 even stronger indication)
alcoholic liver disease
77
management of alcoholic liver disease
prednisolone (glucocorticoids) - acute episodes
| pentoxifylline (sometimes used)
78
```
splenomegaly
ascites
hepatic encephalopathy/confusion
lower conjugated bilirubin
lowered production of coag factors and albumin
jaundice
pruritus
bruising
```
cirrhosis
79
Ix for cirrhosis
Transient Elastography/fibroscan used most to assess the extent of fibrosis in the liver
LFTs may be derranged = low albumin, prolonged PT
Screening Ix
- endoscopy - variceal
- afp - every 6/12 to assess risk of hepatocellular cancer
80
management of cirrhosis
irreversible = prevent underlying cause
stop alcohol consumption
treat any infections
81
```
A yellow tinge to the skin or eyes (jaundice).
Feeling tired.
Muscle or joint aches and pains.
Tummy (abdominal pain).
A poor appetite.
Feeling sick (nausea).
Darker-coloured urine and pale-coloured stools.
Headache.
A high temperature (fever) in some cases
```
hepatitis
>6months = chronic heaptitis
82
hepatitis B serology
HBsAg = acute hepatitis
IgM = acute
IgG = previous
Anti-HBs implies immunity
core antigen = chronic
surface antigen = acute
83
Hepatitis B management
pegylated interferon-a first line
anti-virals = tenofovir, entecavir and telbivudine
prevention with Hep B vaccine = 2, 3 and 4 months of age
84
a transient rise in serum aminotransferases / jaundice
fatigue
arthralgia
hx of IV drug use
Hep C hepatitis
85
management of Hep C hepatitis
currently a combination of protease inhibitors (e.g. daclatasvir + sofosbuvir or sofosbuvir + simeprevir)
+/- ribavirin are used
86
jaundice
raised AFP
B symptoms
ascites, RUQ pain, hepatomegaly, pruritus, splenomegaly
hepatic cancer/neoplasm
87
Ix of hepatic neoplasm
CT/MRI
| serial CT and aFP measurments
88
management of hepatic neoplasm
surgical resection
chemo/radiotherapy
tumour ablation
89
common hepatic neoplasms
cholangiocarcinoma and hepatocellular carcinoma
90
severe epigastric pain - radiates to back
vomiting common
low grade fever
cullen's signs (periumbilical discolouration)
grey turner's sign (flank discolouration)
ileus
hx of gallstones or excessive alcohol consumption
acute pancreatitis
91
Ix for acute pancreatitis
raised lipase, amylase
| US/contrast induced CT
92
management of acute pancreatitis
fluid resus - aggressive hydration with crystalloids
IV opioids
enteral nutrition provided
if due to gallstones = cholecystectomy
if biliary obstruction = ERCP
necrosis = debridement and fine needle aspiration
93
epigastric pain worse 15-30 mins after a meal
steatorrhea
diabetes mellitus
chronic pancreatitis
94
Ix for chronic pancreatitis
pancreatic calcification on abdo X-ray or CT
| faecal elastase
95
chronic pancreatitis management
pancreatic enzyme supplements
analgesia
antioxidants
96
```
painless jaundice
pale stool, dark urine and pruritis
anorexia
weight loss
epigastric and back pain
steotorrhoea and DM
```
pancreatic cancer
97
Ix for pancreatic cancer
CT = double duct sign
| can do US
98
management of pancreatic cancer
surgery - usually very little suitable for surgery
| adjunctive chemotherapy
99
RUQ pain
fever
positive murphy's sign
mildly deranged LFTs
Acute cholecystitis
100
Ix for Acute cholecystitis
Ultrasound
101
management for Acute cholecystitis
cholecystectomy (ideally within 48hrs)
102
RUQ pain - colicky
| following fatty meal
Gallstones/cholethiasis
103
Ix for Gallstones/cholethiasis
US/MRCP
| LFTs
104
management of Gallstones/cholethiasis
laparoscopic cholecystectomy
105
very unwell pt
RUQ pain
jaundice
cholangitis
106
herniation of part of the stomach above the diaphragm
| GORD symptoms
hiatus hernia
107
management
lifestyle changes
PPI
Surgery
108
groin lump
superior and medial to the pubic tubercle
disappears on pressure or when the patient lies down
discomfort and ache: often worse with activity, severe pain is uncommon
usually in males
inguinal hernia
109
management of inguinal hernia
mesh repair is associated with the lowest recurrence rate
either open or laproscopic
110
ascites
abdominal pain
fever
usually hx of cirrhotic liver
peritonitis
111
diagnosis for peritonitis
paracentesis: neutrophil count > 250 cells/ul
112
management for peritonitis
IV cefotaxime
